Melatonin secretion decreases with age and in neurodegenerative diseases like Alzheimer's Disease (AD). Sundown syndrome ("sundowning"), characterized by agitation, wandering, anxiety, aggression and confusion in the evening and at night is prevalent among demented patients.
Issue 6 (Jun)
The patient was a 42-years-old vegan man, without any risk factor for atherosclerosis, admitted with the diagnosis of non-ST segment elevation myocardial infarction after a common cold. Coronary angiography revealed three-vessel Spontaneous Coronary Artery Dissection (SCAD) in diagonal, obtuse marginal and right coronary artery extending to posterior left ventricular artery.
Giant Cell Tumor (GCT) is a rare primary skeletal lesion accounting for approximately 5% of all primary bone tumors in adults. GCT has been described histologically as a benign neoplastic lesion. It clinically presents as painless, firm, well defined mass without any fixity to underling structures. Although it is benign in nature but rarely GCT may exhibit a much more aggressive phenotype.
Mucormycosis is a fungal disease that evolves rapidly and is associated with a high risk of morbidity and mortality in immunodepressed patients, and which requires multidisciplinary medical and surgical approach. Invasive Fungal Infections (IFIs) is still a diagnostic and therapeutic issue.
Inflammatory myofibroblastic tumors are rare benign tumors of unknown etiology. Initially described in the lungs, they have been observed in several other locations, mainly abdominal and pelvic. Cervicofacial localization is very rare and orbital localization is exceptional. We report the case of inflammatory myofibroblastic tumor localized on the floor of the orbit in a 45 years old patient.
Single ventricle hearts have only one ventricle that can pump blood effectively and the treatment requires three stages of operations to reconfigure the heart and circulatory system. At the second stage, Glenn procedure is performed to connect Superior Vena Cava (SVC) to the Pulmonary Arteries (PA).
The Double J stent, or DJ stent, is a self-retaining ureteral stent that is widely used in urologic practice. The primary goal of the DJ stent is to enable adequate kidney drainage into the urinary bladder. However, because of widespread use, lack of patient education, or due to a lack of adherence to regular follow-up, patients may end up with a forgotten DJ stent, which can stay undiagnosed in the pelvi-ureteral system for years and cause a lot of complications before coming to attention.
A 59-years-old woman presented to the emergency department with sudden onset of intermittent hematemesis and melena. The patient had a history of stage IV cervical cancer, sigmoid colostomy (because of rectovaginal fistula). A complete blood count showed normocytic anemia (79 g/l) and other laboratory evaluation showed the elevation of ammonia (38 ?mol/l).
Kikuchi-Fujimoto's Disease (KFD) is rare, benign and more frequent in Asia. It is characterized by the appearance of lymphadenopathies and fever. Histological examination of the lymph nodes make the diagnosis. It is a self-limited disease. Relapses rarely occur. We described a case in Europe, with the particularity of having presented recurrence.
Bloating is a common symptom reported in Gastroenterology clinics. A 37-year old man presented with history of abdominal bloating and increased frequency of stools for two months which was not relieved with pro-kinetic drugs or proton pump inhibitors. His physical examination was unremarkable. Lab tests and abdominal USG were normal.
The patient is a 56 years old female who presented to the office with a complaint of blurry vision OS for a few weeks. Upon initial encounter, several pigmented macules were visible around the left eye and on the lids. The patient mentioned she had these lesions since birth.
Pheochromocytomas and paragangliomas are catecholamine tumors with metastatic potential. In expert centers, new techniques have been developed, especially for the management of metastases in interventional radiology. However, during any therapeutic procedure, there is a risk of release of catecholamines.
The incidence of prostate cancer in Bulgaria is steadily increasing over the last few decades. While the therapeutic strategy for hormone sensitive prostate cancer is well established, Metastatic Castration-Resistant Prostate Cancer (mCRPC) is still a challenge with an average life span of not more than two years.
Mitral valve disease is more common than Aortic valve stenosis in the developing world. Surgical approach has remained the gold standard in management of degenerative and failed bioprosthetic Mitral Valve Regurgitation (MR). However, with the success of Transcatheter Aortic Valve Implantations (TAVI), the percutaneous replacement of a diseased Mitral Valve (MV) is also becoming a viable option in select patients.
Cushing disease is considered as a rare condition characterized by the increases secretion of the Adrenocorticotropic Hormone (ACTH) due to a pituitary adenoma that ultimately causes endogenous hypercortisolism state by stimulating the adrenal glands. Cushing disease is associated with many complications like short stature, weight gain, osteoporosis, cardiovascular and respiratory disorder which leads to high rates of morbidity and mortality.
Diabetes mellitus can lead to long-standing complications in multiple arenas. An area that is often overlooked is implications for major surgery. Spinal decompression and fusions have unique challenges in the diabetic patient. In this review, we briefly highlight the pathophysiology of diabetes mellitus prior to examining implications for spinal surgery. We focus on the wound healing process, surgical infection risk, and delayed fusion.
Rickets usually caused by deficiency of vitamin D and it's a condition which affects bone development and leads to softening and weakling of bones in children. But there are rare inherited problems reported which leads to rickets and these are, Vitamin D Dependent Rickets Type 1, Vitamin D Dependent Rickets Type 2 (also known as Vitamin D resistant rickets) and 25 hydroxylase deficiency rickets.
A 64 year old male patient presented with ulcerative colitis exacerbation along with dyspepsia, nausea and weight loss. He was found to have stool Clostridium Difficilis toxin test positive and H.Pylori stool antigen positive. It is rare to have both of these infections in the same patient and there is no guideline on management of this co infection.
Mutation in TBX18 is rare. It was linked to some various phenotypes mainly congenital anomalies of the kidneys and urinary tract but never renal angiomyolipoma. Here we report the first association of renal angiomyolipoma and mutation in TBX18 and we detailed genetic analyses of renal angiomyolipomas as well as consequences of mutation in TBX18 in humans.
25-year-old male with a history of polysubstance abuse (cocaine and crystal meth) and risky sexual behavior, who presented with a 1-month history of intermittent hematochezia, loose stools and lower abdominal pain. ROS revealed subjective fevers, night sweats, and chills for the preceding 4 days. He used intra-rectal cocaine and crystal meth injection with a needleless syringe.
We're reporting a 35-year-old gentleman that presented with a rare combination of ipsilateral fracture of both proximal and distal ends of the radius associated with ulna styloid fracture due to a fall with outstretched hands. Thorough clinical examination of two adjacent joints (elbow and wrist) is critical in identifying such an unusual or rare combination of injuries.
We present a rare cause of gastrointestinal bleeding resulting from fistulae between the mesenteric artery and portal venous system, caused as a late complication of sleeve gastrectomy. A high index of suspicion, based upon venous engorgement without an occluding thrombus, enabled prompt diagnosis and occlusion of the fistulae with coils, leading to marked clinical improvement.
Brown-Sequard Syndrome (BSS) is a neurological disorder caused by hemisection lesion of the spinal cord. BSS causes can be dichotomized in traumatic and atraumatic, and they can include vascular causes, as ischemia or haemorrhage. We describe the case of a 52-year-old woman presenting with limbs paraesthesia and right leg hyposthenia, associated with cervical acute nontraumatic pain (C6-C7 level).
An 80-year-old female with a past medical history of chronic heart failure with reduced ejection fraction, Aortic valve replacement, atrial fibrillation, and recurrent pulmonary embolism on Xarelto presented to the ER with complaints of cough, shortness of breath, and head trauma following a fall.
A 32-year-old female patient, primiparous, with no particular pathological history, presented a painful cutaneous nodule located at the perianal level of the left buttock evolving since her delivery 3 years ago, and through which seropurulent fluid flows intermittently. The symptomatology evolved in a context of apyrexia and conservation of the general state.
We present the case of a 69-year-old woman diagnosed with neoplasia of the midrectum, requiring abdominoperineal amputation in 2016, and repair of a perineal hernia observed during follow-up in 2018, with placement of a Ventralex-type mesh. Consultation in 2019 for suspected recurrence of perineal hernia confirmed by MRI.
A 17 years old girl presented with complaints of painful, swollen and bleeding gums. On examination, she had diffuse reddish nodular gingival swelling with dusky margins that bleed. Her inflammatory markers were high, including markedly elevated anti-PR3 (147.2 AU/ml).
Shone's Anomaly (SA) is a rare congenital cardiac malformation that consists of four obstructive lesions of the left heart and the aortic arch. We report on a preterm infant with Respiratory Distress Syndrome (RDS) diagnosed with SA after cardiac auscultation revealed a loud second heart sound.
A 58-year-old female with advanced lung cancer, hypertension, hyperlipidemia, pulmonary artery thrombosis, bilateral subclavian artery stenosis, and vocal cord dysfunction presented to the ER with cough, shortness of breath, dysphagia, and weight loss. HR 114 bpm, RR 24/min, SpO2 95% on 4L, Temperature 36.2oC. She was lethargic, chronically ill-looking, and had bronchial breath sounds and crackles in the right upper lobe.
Recent epidemiological studies have reported an increase in cardiovascular morbidity and mortality in Rheumatoid Arthritis (RA). The most common cardiac involvement in RA is pericarditis, followed by myocarditis, coronary vasculitis, then aortitis. However, valvular heart disease has been rarely reported especially the aortic one.
Cerebrovascular malformations include a broad spectrum of intracranial blood vessel disorders, involving the arterial wall, capillary bed, venous and lymphatic systems. Their main associated risks are intracerebral hemorrhage, seizures and focal neurological deficits. We carried out a retroprospective study over a period of 45 months (3 years and 9 months), ranging from April 01, 2018 to December 31, 2021.
To describe the complexities and challenges in managing very complex and fascinating cases of Covid-19 in pregnancy at a district hospital in the UK. A 44-year-old African lady, G6P0+5 dichorionic diamniotic IVF twins, BMI 28kg/m2, complex medical history (essential hypertension, non-functioning pituitary macro-adenoma, partial hypopituitarism leading to diabetes insipidus, hypothyroidism, low cortisol, previous myomectomy, laparoscopies.
The emergence of bacterial resistance is creating a global health issue. The newer generations of antimicrobials used to combat this problem are expensive and their adverse effects are also notable. Natural herbal remedies have shown promising antimicrobial properties and fewer side effects compared to synthetic antimicrobial agents.
Gastric pneumatosis is an unusual and rare condition with unclear management recommendations. We report a case of gastric pneumatosis in an adult patient with multiple myeloma on chemotherapy with concomitant fungemia. Patient presented with right lower abdominal pain and subsequently developed spinal cord compression and got treated with high dose dexamethasone and chemotherapy.
Syndrome of inappropriate anti-diuretic hormone (SIADH) sometimes occurs in patients with lung cancer, and it has been reported as a complication after chemotherapy with platinum agents. A 55-year-old woman relapsed after right lower lobectomy for adenocarcinoma harboring uncommon EGFR mutations (G719A in exon 18 and L861Q in exon 21).
A nine-year-old male presenting with neck pain and head tilt was referred for neurosurgical evaluation. According to the referring pediatrician, the head tilt and torticollis had persisted for the previous three weeks. Of note, a prodromal upper respiratory viral illness was reported, with erythema of the left mastoid area that had resolved after a few days of conservative management.
Plexiform neurofibroma (PN) is a subtype of neurofibroma that is rather uncommon in the clinic. Plexiform neurofibroma is usually associated with neurofibromatosis type I (NF1). Only very few patients have isolated PN, which means they have neither NF1 signs nor relevant family history. Solitary PN is extremely rare. There have been no instances of finger back PN or solitary PN all around the world, which could lead to misdiagnosis, missed diagnosis, and mistreatment.
This study was performed to evaluate the densitometric values and the type of corneal topographic pattern extracted from Pentacam HR (OCULUS, Wetzlar, Germany) in two groups of severe delayed-onset mustard gas keratopathy (DMGK) and old herpes simplex corneal scarring. Twenty eyes of each group were enrolled to the study and were examined using the Pentacam HR.
COVID-19 predisposes to a hyper-coagulable state. Thromboembolic sequelae of COVID-19 might be the first presentation of the disease. A raised titer of anti-SARS-CoV-2 antibodies might suggest an underlying pro-thrombotic milieu secondary to post-COVID status. The present case report cites a 29-year-old obese male presenting with acute pulmonary embolism and right atrium to right ventricle thrombus in transit diagnosed to be post-COVID on the basis of raised anti-SARS-CoV-2 antibodies.
To report a case of unilateral blindness following nasal septoplasty. A 38 years old man, who referred to ophthalmology service one day after nasal septoplasty. He complained of vision loss in his right eye and right eye lids swelling and ecchymosis. The paranasal and orbital computed tomography scan revealed direct traumatic lesion to medial part of optic nerve in orbital apex.
Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitides (AAVs) are characterized blood vessel inflammation and necrosis which may lead to diffuse alveolar hemorrhage (DAH) resulting in life threatening respiratory failure. We present a case of microscopic polyangiitis presented in respiratory failure secondary to DAH that developed a rare treatment related complication.
Bilateral anterior fracture dislocation of the shoulder secondary to a high voltage electric shock is extremely rare, with only a few case reports available. To our knowledge, a prolonged delayed presentation (>4 weeks) of an anterior fracture dislocation of the shoulder has not yet been reported in the English literature.
The patient (DH 8993), a mail, 17 years old, a resident of the rural district of the Zhambyl region of Kazakhstan, participated in the cutting and butchering of farm animals. He became acutely ill on 2.12.21 (1 day of illness), - the temperature increased (up to 38), headache, weakness appeared, appetite decreased. There was vomiting.
Adrenal cysts are uncommon lesions that are usually benign, with an incidence of 0.06-0.18%. Pseudocysts are the second most common type of adrenal cyst. We present the case of a 57-year-old female whose CT scan of the abdomen incidentally revealed a 7.2 cm right adrenal tumor with peripheral calcifications. Due to its large size and unusual CT findings, resection was indicated.
MELAS is maternally-inherited encephalomyopathy, characterized by seizures, migrainous headaches, lactic acidosis, vomiting, and recurrent stroke-like episodes. The strokes are affecting mainly the cerebral cortex and can be visualized by MRI. Most of the reported cases in the literature present with no enhancement or slight enhancement on MRI enhanced scan, but exhibiting multiple nodular enhancement and dural enhancement has never been reported.
Fahr's syndrome is a rare neurodegenerative disorder characterized by abnormal symmetrical calcifications of the basal ganglia, thalami, subcortical hemispheric white matter and deep cerebellar nuclei. The most common clinical presentations are movement disorders, pyramidal signs, parkinsonism, gait disorders, cerebellar anormalities, psychotic symptoms and cognitive disorders. This article discusses rare presentation of Fahr's syndrome with epileptic seizure.
Unilateral absence of the pulmonary artery (UAPA) is an infrequent finding, with an estimated prevalence of 1 in 200,000 young adults. The percentage of syndromic UAPA is not known but mostly does not have a syndromic association, only being reported with the 22q11 deletion syndrome. We present the case of a baby boy with peculiar facies and UAPA, who developed severe bilateral pulmonary fibrosis.
The aim of this study is to determine adhesion formation rate and antrostomy closure rate after the use of Mitomycin-C in patients underwent FESS. This is a prospective case control study conducted at ENT Department Lyari General Hospital, Karachi, Pakistan. Fifty one patients included with diagnosis of bilateral chronic rhinosinusitis or allergic fungal sinusitis and were the surgical candidate, underwent bilateral Functional Endoscopic Sinus Surgery (FESS).
Edentulism is having few or no teeth in the oral cavity, which is an irreversible condition. It has been shown to be more prevalent in the aged especially among the female. Edentulism which is an age related problem is associated with inability to eat, which render the aged deficient of essential vitamins and minerals.
Intestinal wall hematoma can occur after a blunt abdominal trauma or can be a spontaneous event. Spontaneous intramural rectal hematomas are rare but can occur in patients taking anticoagulant therapy or with hematologic disorders and associated blood clotting disorders. We present a case of a spontaneous symptomatic rectal wall hematoma occurred 10 years after a stapled hemorrhoidopexy which was successfully treated with non-operative management.
A 41-year-old woman presented to our office, around valentine's day, complaining of cervical discomfort. On physical examination, a midline cervical mass was identified. A cervical ultrasonography (Figure 1a and 1b) showed a heart shaped hypoechogenic colloidal cyst (3.4 X 3.5 X 3.5 cm) in her left thyroid lobe containing a hyperechogenic heart shaped colloidal aggregation.
A paratesticular fibrous pseudotumor is a relatively rare benign disease. Preoperatively diagnosing a fibrous pseudotumor is challenging because distinguishing these masses from malignant tumors on the basis of clinical and radiological findings is difficult to see impossible. We present a case of a 34-year-old man who presented with a 2-year history of right testicular swelling and was advised right radical orchidectomy by another surgeon.
The patient is a 70-year-old man presented with dyspepsia, abdominal pain, nausea, vomiting and bone pain more severe in ribs, pelvis and lower extremities. Immunohistochemistry assay revealed positive Ki67 of the liver metastases . Abdominal ultrasound revealed multiple hyperechoic lesions in the liver that the largest one was 57 mm X 49 mm.
Amyloidosis encompasses a group of disorders involving extracellular deposition of an abnormally folded protein. Light chain amyloidosis is a common type of systemic amyloidosis and is typically associated with an underlying plasma cell neoplasm. Here we describe an uncommon presentation of light chain amyloidosis.
Vibrio is gram negative bacteria found in warm salty water. Vibrio vulnificus is one of the most common species causing vibriosis in the United States. It is associated with primary sepsis, skin infections as well as gastrointestinal tract infection. Here we present a case of Vibrio vulnificus bacteremia in a hemodialysis dependent ESRD patient.